Validity and Reliability Study of the Chinese (Traditional) Version of the Devereux Early Childhood Assessment for Toddlers (DECA-T).

BACKGROUND: The Devereux Early Childhood Assessment for Toddlers (DECA-T), which is one of the few standardized, norm-referenced behavioral rating scales related to young children's mental health, resilience, and social-emotional development, was developed for toddlers aged between 18 and 36 months. OBJECTIVE: The aim of this study was to test the clinimetric properties of the Chinese (Traditional) version of the DECA-T (C-DECA-T) using a classical test theory analysis and an item response theory analysis. METHODS: Seventy-five community-based toddlers aged from 18 to 36 months and 50 clinic-based participants recruited in hospitals in northern Taiwan participated in this study. Social-emotional competence was assessed by the C-DECA-T and children's behavior problems were rated via the Child Behavior Checklist 1.5 to 5 (CBCL/1.5-5). Homogeneity of the C-DECA-T was assessed by Mokken analysis; sensitivity and specificity were assessed via receiver operating characteristic curve. RESULTS: The results showed the C-DECA-T demonstrated good test-retest reliability (r=0.8) and high internal consistency (Cronbach's alpha = 0.94). Inter-rater reliability between father and mother was fair (ICC = 0.46). Convergent validity of the CBCL/1.5-5 total behavior problems (r=-0.26) demonstrated acceptable psychometric performance. The overall measure of the sampling adequacy of the C-DECA-T assessed by principal component analysis was 0.93. Mokken scale analysis showed the 36-items of the C- DECA-T formed a weak unidimensional scale (Hs =0.35), supporting its construct validity. The area under curve of the C-DECA-T in prediction of social-emotional disturbance was 0.70. The optimal cutoff of the Total Protective Factor score of the C-DECA-T was a T score of 40.1 (T40.1), with a sensitivity of 95% and a specificity of 68%. Item 2 ("show affection for a familiar adult") and item 33 ("calm herself/himself") provide a good amount of information for the assessment of social-emotional strength and needs of a toddler in clinical practice. CONCLUSION: The C-DECA-T showed good psychometric properties. Our findings of high internal consistency of the three subscales and total score of the C-DECA-T suggest symptom manifestation of social-emotional competence and needs in Taiwanese toddlers is not culturally different from American toddlers. The clinimetric properties of the C-DECA-T examined by a classical test theory analysis approach and an item response theory analysis approach suggest that the C-DECA-T is a reliable and valid instrument for measuring social-emotional strength and needs in the population in Taiwan.

Validity and reliability of the Chinese version of the Sheehan Disability Scale (SDS-C).

INTRODUCTIONS: This study aims to evaluate the validity and reliability of the Chinese version of the Sheehan Disability Scale (SDS-C) among depression patients in Taiwan. METHODS: To validate the SDS-C, two samples were selected: Sample 1 (n = 78) consisted of patients diagnosed with Depressive Disorder, while sample 2 (n = 63) consisted of a nondepressive population. Sample 1 was evaluated with SDS twice with 7-14 days interval to measure test-retest reliability. Both samples were also evaluated with The Centre for Epidemiologic Studies Depression Scale (CESD), Family APGAR (adaptation, partnership, growth, affection, resolve) score, the Global Assessment of Functioning (GAF), and brief questionnaire of the World Health Organization Quality of Life instrument (WHOQOL-BREF) and by a psychiatrist. The two samples were combined to measure validity. RESULTS: In concurrent validity, SDS-C scores were significantly correlated with the total score of GAF. The discriminative validity was carried out by comparing the score of SDS-C between subjects with and without current depressive disorder (t = 12.32, df = 139, P < 0.001). Another discriminative validity by receiver-operating characteristic analysis showed the optimal cut-point was >11 (sensitivity: 82.1, specificity: 93.7). The area under the curve was 0.93 (±0.02). For the factor validity, principal components analysis showed that a single factor solution was the best solution accounting for 88.9% of the variance. Regarding the construct validity, SDS-C scores were significantly correlated with CESD, WHOQOL-BREF, and the Family APGAR score. For test-retest reliability, the intra-class correlation coefficient for the total SDS-C score was 0.89 (95% confidence interval 0.82-0.93) and internal consistency Cronbach's alpha was 0.94. DISCUSSION: The SDS-C was found to be a valid and reliable instrument for current depressive disorder patients in Taiwan.

Differential effects of olanzapine and clozapine on plasma levels of adipocytokines and total ghrelin.

Second-generation antipsychotics (SGAs) have been associated with an increased liability for weight gain and metabolic side effects. Among SGAs, clozapine and olanzapine had great liability to induce weight gain and metabolic adverse reactions. Leptin, adiponectin, and total ghrelin play important roles in energy homeostasis and are suggested to be biomarkers of metabolic disturbances. The purpose of the present study was to investigate the differential effects of antipsychotics (olanzapine and clozapine) on the levels of adipocytokines (leptin and adiponectin) and total ghrelin. Three hundred and thirty-three patients with schizophrenia under clozapine or olanzapine monotherapy were recruited. Control participants were recruited from a healthy community population based on a health investigation (N=119). Fasting blood samples for glucose, cholesterol, triglycerides, leptin, adiponectin, and total ghrelin were analyzed. There were significant differences in the levels of cholesterol, triglycerides, and glucose between these three groups. Post hoc comparisons showed that the olanzapine group had the highest levels of cholesterol and triglycerides. The levels of leptin, adiponectin, and total ghrelin were also significantly different between the three groups after controlling age and body mass index (BMI). Post hoc comparisons showed that the olanzapine group had the lowest levels of adiponectin and total ghrelin. The present study found that the uses of olanzapine and clozapine were associated with changes in adipocytokines and total ghrelin, even after adjusting potential confounding factors. Olanzapine had greater influences on adiponectin and total ghrelin than clozapine. The changes in adipocytokines and total ghrelin were a direct effect of antipsychotics on hormonal pathways of energy homeostasis, rather than the result of weight gain.

Symptoms of attention deficit hyperactivity disorder and quality of life of mothers of school-aged children: the roles of child, mother, and family variables.

This study examined the impact of inattention and hyperactivity symptoms in children and mothers, opposition problems in children, maternal depression, and perceived family support on the quality of life (QOL) of mothers. Mothers of children in one elementary school were contacted. The relationship between sociodemographic variables, the levels of inattention and hyperactivity symptoms in children and mothers, oppositional symptoms in children, maternal depression, perceived family support, and maternal QOL were examined. Three hundred and eighty-two participants were included in this study. Consistent factors related to the mother's QOL in the four domains were maternal depression, perceived family support, and housing status after controlling for several family, maternal, and child variables. Maternal QOL was more related to her own and family factors including maternal inattention, hyperactivity and depression symptoms, perceived family support, and housing status, instead of parent-rated inattention and hyperactivity symptoms of the child. Screening for maternal inattention, hyperactivity and depression symptoms, and mental health services for these mothers are warranted based on these findings.

Prevalence, correlates, and risk perception of HIV infection among heroin users in Central Taiwan.

We investigated the prevalence and correlated factors of human immunodeficiency virus (HIV) among heroin users attending methadone maintenance treatment (MMT) programs in Central Taiwan, and explored the degree of risk perception of HIV infection among the participants. Our study participants were 781 heroin users seeking treatment at the MMT program at Tsaotun Psychiatric Center in Taiwan. The presence of HIV antibodies was identified by microparticle enzyme immunoassay and confirmed by western blot. Multivariate logistic regression was used to identify the independent correlates of HIV infection. The mean age of the sample was 36.1 years [standard deviation (SD) = 7.6]; of the patients, 710 (90.9%) were men. The prevalence of HIV infection among our study population was 20.7%. Multivariate logistic regression analysis revealed that HIV infection was independently associated with the age of the patients of initial heroin use, heroin injection use, nondrug-related criminal convictions, needle-sharing behaviors, and sharing injection paraphernalia. A strong agreement existed between self-reported HIV serostatus and the results of laboratory analyses, with 88.8% of patients reporting their condition correctly. We found a high rate of HIV infection among patients in the MMT program. Factors associated with HIV infection were mostly related to drug-use behaviors. These findings stress the importance of education regarding drug-risk behaviors.

Risk and predictors of suicide and non-suicide mortality following non-fatal self-harm in Northern Taiwan.

OBJECTIVE: To investigate the risk and predictors of suicide and non-suicide mortality after self-harm in a Taiwanese population. METHOD: Between July 2006 and June 2008, 3,299 individuals who harmed themselves were recruited to a population-based self-harm register in Taoyuan County, Taiwan. They were followed until December 2008, with record linkage for date and cause of death in a national mortality database. RESULTS: In total, 115 individuals died, 52 through suicide. The risks of suicide and non-suicide mortality in the first year were 1.5 and 2.2%, respectively, representing an approximately 75-fold and 5-fold age- and gender-standardized increase compared with the general population in Taiwan. Male gender, rural residence, more lethal methods of self-harm and self-cited stressors for the index self-harm episode (unemployment, and chronic somatic illness) were independent risk factors for suicide mortality. Male gender, older age, rural residence and more lethal methods of self-harm were also independent risk factors for non-suicide mortality. The association between of unemployment as a cited reason for self-harm and later suicide was strongest in men and in those aged more than 45 years. CONCLUSIONS: Relatively high rates of suicide and non-suicide mortality were found following self-harm. Suicide prevention needs to take into account of risk factors for fatal repetition of self-harm.

High prevalence but low awareness of hepatitis C virus infection among heroin users who received methadone maintenance therapy in Taiwan.

BACKGROUND: This study investigates the prevalence and correlates of hepatitis C virus (HCV) infections among heroin dependent individuals who received methadone maintenance therapy in Taiwan. Also, we investigate users' awareness of HCV. METHODS: Participants were 773 heroin users entering the methadone maintenance treatment (MMT) program at Tsaotun Psychiatric Center in Taiwan. The presence of HCV antibodies was detected. Multivariate logistic regression was used to identify the relationship between HCV infection and correlates. RESULTS: The prevalence of HCV infection was 90.8%. All participants who were HIV-positive were also infected with HCV. Multivariate logistic regression analysis showed that the route of heroin administration (injection), HIV-infection, and criminal records were significantly related to HCV infection. Few (34.8%) HCV positive heroin users were aware of their infection. CONCLUSION: An extremely high prevalence of HCV infection but low awareness of their infection status was found among MMT patients in Taiwan. These findings highlight the importance of education regarding risky behaviors and the necessity for HCV treatment for this population in Taiwan.

Medical education in Taiwan.

Taiwan's medical education system bears a close relationship with its colonial and post-colonial history. Since the late nineteenth century, Western medicine, Chinese medicine, and the practice of the other forms of traditional healing have encountered complex transactions with the state and one another, eventually evolving into the present medical system. Nowadays, the mainstream form of medical education in Taiwan is a 7-year Western program; other forms of medical education include a 5-year graduate program and traditional medicine programs. Challenged by the National Health Insurance that emphasizes cost management since 1995 and criticized by the US National Committee on Foreign Medical Education and Accreditation in 1998, medical education reform was implemented by the Taiwan Medical Accreditation Council established in 2000. The reform tries to bring humanities into various aspects of medical education, including student recruitment, curriculum, licensing, and continuing education. Similar to other modernization projects, the reform transplants the American and British standards to Taiwan. These changes hope to insure the reflective capabilities in physicians on the welfare of patients. However, frustration of current and future physicians may be deepened if the reform is insensitive to local issues or incapable of addressing new global tendencies.

Weight gain and ghrelin level after olanzapine monotherapy.

BACKGROUND: The present study aimed to explore the association between weight gain and ghrelin among schizophrenic patients under olanzapine treatment. The relationships among weight gain and adiponectin, fasting glucose, and lipid profile were also investigated. METHODS: This case-control study recruited 66 schizophrenic patients from the Chung Shan Medical University Hospital in central Taiwan. All of them were undergoing olanzapine monotherapy and were categorized into weight gain (WG) and non-weight gain (NWG) groups. Subjects in the control group (CG) were recruited from a healthy community population based on a health survey (n=119). Multivariate logistic regression was used to explore the association of ghrelin with weight gain. RESULTS: The 66 schizophrenic patients had a mean age of 36.3±9.6 years, with 50% females. They received olanzapine treatment for a mean period of 8.3±7.5 years. The control group had a mean age of 38.9±9.3 years and 52.9% were females. Comparing fasting serum ghrelin levels, the WG group had the lowest mean value (822.3±253.1 pg/ml) while the control group had the highest mean value (1261.2±1639.7 pg/ml), with a significant difference between the two (p=0.01). In contrast, there was no difference in adiponectin levels among the three groups. The WG and NWG groups had higher diastolic blood pressure than the control group, but systolic blood pressure was the same in all three groups. There was no difference in the total cholesterol level although the WG and NWG groups had higher triglyceride (TG) and glucose levels than the control group. CONCLUSIONS: Weight gain after olanzapine treatment is associated with lower ghrelin level. Olanzapine is linked to elevated diastolic pressure, TG, and glucose, regardless of the weight gain.

Suicide and unemployment rate in Taiwan, a population-based study, 1978-2006.

OBJECTIVE: Both the suicide rate and unemployment rate have showed an upward trend in Taiwan since 1994. This study aimed to explore the association between the suicide rate and the unemployment rate. This information is useful in developing specific suicide prevention strategies related to unemployment. METHODS: All the cases of suicide by those aged 15 years and above during 1978-2006 in Taiwan (n = 74,064) were included in this study. Time series models were used to analyze the monthly age-standardized suicide rate by gender and age-subgroup (15-24, 25-44, 45-64, and 65+). RESULTS: With regard to the age range and gender subgroup, the association between age-standardized suicide and the unemployment rate was comparatively high for males and those aged from 45 to 64 years. Among males and those aged from 45 to 64 years, a 1% increase in the absolute unemployment rate was associated with a 4.9% (95% confidence interval: 1.7-8.2) increase in the relative age-standardized suicide rate in the monthly average from 1978 to 2006 in Taiwan. CONCLUSIONS: Suicide prevention strategy for the unemployed should be more focused especially on males aged from 45 to 64 years in Taiwan.

The validation study and application of stratum-specific likelihood ratios in the Chinese version of SPAN.

The Davidson Trauma Scale (DTS) is a validated self-rating scale used in the diagnosis of post-traumatic stress disorder (PTSD). A shorter version of the DTS was developed to serve as a diagnostic screening tool. A four-item scale, the SPAN (named for its principal four items: Startle, Physiological arousal, Anger, and Numbness), was then developed. This report investigates the psychometric validation of the Chinese version of the SPAN (SPAN-C). Subjects were drawn from a sample of 210 survivors of the September 21, 1999 Chi-Chi Earthquake. The scale showed good internal consistency (Cronbach's alpha= 0.77) and test-retest reliability (r = 0.90). Concurrent validity was obtained against the clinical diagnostic interview, with a diagnostic accuracy of 0.8 at a SPAN-C score of 5. The recommended stratum-specific likelihood ratios were 0.04 (95% confidence interval [CI], 0.02 to 0.07) for the score range of 0 to 2, 0.93 (95% CI, 0.51 to 1.71) for the score range of 3 to 4, 2.31 (95% CI, 1.17 to 4.57) for the score range of 5 to 6, and 5.23 (95% CI, 3.12 to 8.78) for scores above 7. The psychometric strength of the SPAN-C indicates its reliability for future use, particularly for screening for subjects with a possible diagnosis of PTSD.